Anaesthetic Management of Patients Undergoing Bariatric Surgery

Abstract

Objective: To describe perioperative anaesthetic management with laparoscopic sleeve gastrectomy (LSG). Study Design: An observational study. Place and Duration of Study: Department of Anesthesiology, Ondokuz Mayis University, Turkey, between January 2012 and December 2017. Methodology: Patients who underwent LSG at the study centre were considered. Hospital records were retrospectively reviewed. Information was collected on demographic characteristics, comorbidities, haemodynamic parameters, airway and anaesthetic management and complications. Results: The study included 95 patients (mean age, 37.4 +/- 12.1 years; mean body mass index, 46 Kg/m(2)). Despite high airway assessment scores in some patients, 93 patients (98%) were conventionally intubated using our modified ramp position. Anaesthesia induction involved propofol, and anaesthesia maintenance involved inhalation anaesthetics (remifentanil supplementation). Additionally, rocuronium and sugammadex were used. Postoperative pain was managed with multimodal analgesia. Dose calculations were mostly based on lean/ideal body weight. Significant differences were found in the mean arterial pressure, heart rate and arterial oxygen saturation before induction and 5 min after induction. Intraoperatively, 3 patients (3.2%) developed bronchospasm and 1 (1.1%) developed bradycardia. There were no postoperative complications. Conclusion: Inhalational anaesthesia with remifentanil and rocuronium-sugammadex is a safe option in bariatric surgery. Although conventional techniques are sufficient to establish the airway in most cases, preparations for difficult intubation should be made. Furthermore, careful patient selection, preoperative anaesthetic management planning and appropriate postoperative monitoring are necessary.